Clinical Negligence Quantum: Expert Evidence Guide
Clinical negligence claims involving catastrophic injury require coordinated expert evidence across multiple disciplines - medical, care, occupational therapy, accommodation, and quantum. The forensic accountant or quantum expert integrates these inputs into a Schedule of Loss that capitalises future pecuniary losses.
This guide explains all recoverable heads of damage, the post-George v Biggs approach to accommodation, periodical payments versus lump sum awards, and how solicitors should manage the quantum expert's role through to trial.
All Heads of Damage in Clinical Negligence
Clinical negligence damages include: general damages (PSLA - assessed by the court using Judicial College Guidelines, not quantified by the expert); past special damages (care, treatment, equipment, loss of earnings to trial, travel, accommodation); and future special damages (care, case management, loss of earnings, pension loss, equipment, Court of Protection costs, accommodation). The quantum expert calculates and presents all pecuniary heads in the Schedule of Loss. CRU benefit deductions must be applied to past care and NHS treatment recoveries. Interest on past special damages is calculated under s35A. The expert does not opine on PSLA but must ensure pecuniary heads do not overlap with general damages awards.
George v Biggs and Accommodation Costs
Following George v Biggs [2023], the Roberts v Johnstone formula for accommodation no longer applies. Claimants may recover the full capital cost of disability-adapted accommodation, with a deduction for the value of property they already own or could reasonably afford without adaptation. The accommodation expert assesses the capital cost of suitable property; the quantum expert presents the net claim after deduction. This change materially increased accommodation recoveries when the discount rate was negative and Roberts v Johnstone produced nil awards. Reports must cite George v Biggs explicitly and avoid outdated Roberts v Johnstone calculations that defendants will challenge immediately.
PPO vs Lump Sum: Modelling Both Scenarios
Under the Damages Act 1996, the court may order periodical payments for future care, earnings-related losses, and other heads instead of a lump sum. PPOs provide annual payments indexed to ASHE (or another index), protecting the claimant against investment risk and longevity. Lump sums give immediate capital but require careful investment management. The quantum expert - often with actuarial input for PPO modelling - prepares both scenarios: lump sum capitalisation via Ogden Tables and PPO annual payments with escalation assumptions. The court compares net present cost, claimant preference, and defendant's PPO offer (which the claimant cannot be compelled to accept without court order). Early PPO modelling supports settlement discussions.
The Schedule of Loss in Clinical Negligence
High-value clinical negligence Schedules are complex multi-disciplinary documents. The quantum expert coordinates inputs from: the care expert (hours, rates, life expectancy); the occupational therapist (equipment, adaptations); the accommodation expert (capital costs); the medical expert (life expectancy, capacity for work); and the case manager (annual case management fees). Each future head is capitalised separately with appropriate Ogden multipliers - care and case management may use different life expectancy assumptions if medical evidence supports it. The Schedule should be updated as trial approaches and new expert evidence is served, with supplementary quantum reports supporting material revisions.
The Quantum Expert's Role and Coordination
The quantum expert is the financial integrator of the claim - not a substitute for care or medical experts. Instruct the quantum expert once care and life expectancy evidence is available or anticipated on a stated assumption basis. The expert should attend joint expert meetings with the defendant's quantum expert to agree life expectancy, care hours, and methodological approaches where possible. For Court of Protection cases, the expert may also quantify deputy and management costs. APIL-accredited forensic accountants with clinical negligence experience understand the interplay between heads and the defendant's typical challenges - instruct early to avoid Schedule revisions that delay trial.
Need a damages expert witness?
Tell us about your matter and we will connect you with a qualified quantum specialist. Response within one business day.
Submit an enquiry